14D2156257 CLIA NUMBER - BACK TO BASICS PEDIATRICS, S C

Laboratory Demographics

  • CLIA Code: 14D2156257
  • Facility Name: BACK TO BASICS PEDIATRICS, S C
  • Facility Address: 2403 HARNISH DR - STE 101
    ALGONQUIN, IL
    ZIP 60102
  • Facility Phone: 224 333-0730
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTINE M. POULOS M D
  • NPI Number: 1205310356
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D2156257
LAB Type Physician Office
Facility Name BACK TO BASICS PEDIATRICS, S C
Street 2403 HARNISH DR - STE 101
City ALGONQUIN
State IL
ZIP 60102
Phone 224 333-0730
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2024
Certificate Expiration Date 10/11/2026
Facility Type Physician Office
Lab Director CHRISTINE M. POULOS M D

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This page was last updated on: 9/29/2025